Tumor Linkage and Consolidation Program

1
Tumor Linkage and Consolidation Program

• Robin D. Otto, RHIA, CTR
• Pennsylvania Cancer Registry
• NPCR Program Directors Meeting
• May 4, 2005

2
Tumor Linkage and Consolidation

• Tumor Linkage Multiple Primary Determination
• Data Item Consolidation Best Value Selection
  for
• Patient and tumor information for the same
  primary
• Patient information for new primaries

3
Benefits of Automating Tumor Linkage and
Consolidation

• Retains accuracy
• Increases consistency
• Provides ability to automate some decisions and
  provide manual review for others
• Decreases staff time committed to this aspect of
  Registry Operation
• Increases staff time available to address more
  difficult cases and other quality assurance
  activities

4
Automated Tumor Linkage and Consolidation Program

• TLC Plus is the automated Tumor Linkage and Data
  Item Consolidation program within CRS Plus.
• CRS Plus is the main central registry database
  program in CDCs Registry Plus System.

5
Tumor Linkage in TLC Plus

• Data Items
• Primary Site
• Laterality
• Histologic Type (ICDO3)
• Behavior (ICDO3)
• Diagnosis Date
• Reporting Facility

• Outcomes
• Consolidate (new facility for existing tumor)
• New Tumor
• Manual Review

6
Tumor Linkage Logic

• 1. Exact Match
• Identical values for Primary Site, Laterality,
  Histologic Type, Behavior
• Values for Diagnosis Date within 60 days
• Reporting facility can be same or different
• 2. Excluded histologies
• Melanomas, Sarcomas, Retinoblastomas, Lymphomas,
  Hematopoietics
• 3. Linkage Rules Primary Site driven
• Prostate only
• 4. If no site rule set activated, tumor linkage
  decision is made manually.

7
Linkage Rules
8
Data Item Consolidation in TLC Plus

• Data Items
• New Tumor Decision consolidate patient data
  items
• Same Tumor Decision consolidate patient and
  tumor data items

• Outcomes
• Automated value selection
• Manual Review

9
Consolidation Logic

• Logic specific to each data item
• Abstract values are compared, not consolidated
  value against new abstract.
• Unknown values defined
• Automated consolidation applied when all values
  are not equal.
• Automated Consolidation Rules consist of a series
  of Directives.
• If no single value remains after directives
  applied, consolidation is done manually.

10
Consolidation Directives over 25 Directives

• KnownOverUnknown Eliminate Unknown values
  when a Known value is present. (unknown values
  defined)
• MostFrequent - Selects the value that occurs
  most often. Also identifies same value from same
  reporting facility only once when applicable.
• AnalyticEliminatesNonanalytic Uses Class of
  Case to define an abstract as analytic or
  non-analytic, then eliminates values from
  non-analytic records from consideration when both
  analytic and non-analytic records exist.
• ManualIfAmbiguous Requires manual consolidation
  if values differ.

11
Consolidation Rules Data-Item Specific

• Social Security Number KnownOverUnknown
  MostFrequent MostRecent manual review.
• Race KnownOverUnknown manual review.
• Date of Last Contact KnownOverUnknown if Vital
  Status 1 on all abstracts, then latest most
  complete date otherwise manual review.
• Primary Site If Class of Case is blank, manual
  review AnalyticEliminatesNonanalytic manual
  review.
• Laterality Take from abstract used to select
  Primary Site otherwise KnownOverUnknown.
• Diagnostic Confirmation KnownOverUnknown
  LowestCode

12
Example
13
TLC Plus Data Flow
14
(No Transcript)
15
CRS Plus Import Activity Report
16
CRS Plus Import Activity Report continued
17
Future Enhancements

• Tumor Linkage
• Add linkage rule sets after new multiple primary
  determination rules are in effect.
• Data Item Consolidation
• Develop new rules for new data items
• Modify rules as needed to conform to NAACCR
  Consolidation SubCommittee Best Practice
  recommendations.